Premier Physicians is currently seeking a Full Time Precertification Specialist for our Ancillary Department.

Our growing group practice encompasses internal and family medicine, medical and surgical specialties, and has comprehensive on-site diagnostic centers conveniently located in the communities we serve in the Cleveland metro area.

JOB TITLE: Precertification Specialist

REPORTS TO: Department Manager/Supervisor

SUPERVISORY SKILLS: None

JOB DESCRIPTION: The Precertification Specialist is responsible for obtaining prior authorizations for all procedural orders by successfully completing the authorization process with all payers.

DUTIES AND RESPONSIBILITIES:

• Review chart documentation to ensure patient meets medical policy guidelines
• Prioritize incoming authorization requests according to urgency
• Obtain authorization via payer website or by phone and follow up regularly on pending cases
• Maintain individual payer files to include up to date requirements needed to successfully obtain authorizations
• Initiate appeals for denied authorizations
• Respond to clinic questions regarding payer medical policy guidelines
• Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order
• Contact patients to discuss authorization status
• Other duties as assigned

REQUIREMENTS:

LICENSE/CERTIFICATION: None

EDUCATION: High School Diploma or GED

EXPERIENCE:

• Two (2) years medical prior authorization experience preferred
• Two (2) years’ experience in a medical related field required

KNOWLEDGE:

• Knowledge of procedure authorization and its direct impact on the practice’s revenue cycle
• Understanding of payer medical policy guidelines while utilizing these guidelines to manage authorizations effectively
• Basic understanding of human anatomy, specifically musculoskeletal

SKILLS:

• Proficient use of CPT and ICD-10 codes
• Excellent computer skills including Excel, Word and Internet use
• ·Detail orientated with above average organizational skills
• Plans and prioritizes to meet deadlines
• Excellent customer service skills; communicates clearly and effectively

ABILITIES:

• Ability to multitask and remain focused while managing a high-volume, time sensitive workload

PHYSICAL/MENTAL:

• Sitting for up to 8 hours a day. Requires eye-hand coordination, finger dexterity. Must be able to view computer screens for long periods. Occasional stress related to workload and customers with problems.

ENVIRONMENTAL/WORKING CONDITIONS:

• Office setting. Exposure to communicable diseases and other conditions common to the environment.

Equipment/Tools or special clothing required to perform the job:

• Office equipment

This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve.

Job Type: Full-time

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Weekly day range:

• Monday to Friday

Education:

• High school or equivalent (Preferred)

Experience:

• Prior Authorization: 2 years (Required)
• Medical office experience: 2 years (Required)

Work Location: In person